Assessing the effectiveness of state language policies in improving immigrant access to health services

BACKGROUND. In response to federal mandates, states have implemented a multitude of policies to address language barriers to health services. However, limited oversight and enforcement has resulted in a “patchwork” of state policies and to date, little is understood as to their effectiveness in improving immigrant health care disparities. This study examines the effect of state language policies on immigrants and their ability to access health services.

METHODS. Data were drawn from the 2002 National Survey on America's Families (n=40,840 adults in thirteen states) and linked to state policy variables, reflecting the presence or absence of the following policies: direct reimbursement for language services and linguistic requirements for hospital and managed care plans. Bivariate statistics and multilevel modeling were used to test differences in health access outcomes between immigrants from “policy states” versus “non-policy states.”

RESULTS. Immigrants generally fared better in the policy states, particularly those with policies dealing with reimbursement mechanisms or hospital mandates. For example, 79% of immigrants in states with reimbursement policies had a usual source of care, compared to 69% in non-policy states (p<0.05). In many cases, access disparities between immigrants and US-born persons were also relatively smaller in the policy states. Multilevel model results suggested that hospital mandates, in particular, may have a positive impact on between-state disparities in immigrant access to health services.

CONCLUSION. With a growing immigrant population, states play a critical role in eliminating language barriers to health services.